Getting the Right Treatment at the Right Time to Reduce Inequities in Breast Cancer Survival

Wednesday, October 9, 2019 by Division of Cancer Prevention and Control

Although death rates from breast cancer have been going down, the trend has not been equal among all women. Looking at breast cancer survival on a population level can tell us how effective our public health and health care systems are at early diagnosis, delivery of evidence-based treatment, and management of follow-up care. In 2017, CDC published a series of articles on 5-year survival across several cancers. For breast cancer, 5-year survival for all women was high—around 90%—but survival was more than 10% lower among black women compared with white women. This difference persisted across a 10-year span, suggesting that racial inequalities still exist despite great advances in breast cancer treatment options.

Why Inequalities Exist

Breast cancer is often diagnosed at later stages and is more aggressive in African American women. American Indian/Alaska Native women are more often diagnosed at younger ages and have worse survival after diagnosis. And, for women in rural areas, the decrease in breast cancer mortality has been slower. This means that improving early diagnosis and timeliness to treatment are critical for these women.

Many barriers contribute to these inequalities, such as lack of access to high-quality medical care, lack of transportation, mistrust of the health care system, and financial stress that can lead to delays in treatment and ultimately affect the patient’s outcome. In addition, comorbidities such as obesity, diabetes, heart disease, and hypertension are more common among racial minorities and rural women, which may affect their ability to receive or complete treatment.

What Can Be Done

Improving equity in breast cancer treatment and survival requires a coordinated team approach with doctors, nurses, patient navigators, social workers, and others. More efforts are needed to address the social and economic factors, as well as the comorbidities and biological characteristics of breast cancer that may affect outcomes.

Soon after breast cancer diagnosis, it is important that each patient understands her disease and treatment plan. Identifying and addressing barriers, educating patients on healthy lifestyles, and improving comorbid conditions can help women have the best opportunity to receive the cancer treatment they need. Oncology nurses are in a particularly good position to educate, navigate, and advocate for cancer patients. The key is all women getting the right treatment at the right time.